Lawmakers probe $1.2B Ohio Medicaid fraud

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(The Center Square) – Federal lawmakers called for greater fraud enforcement in the Medicaid Waiver Program on Wednesday, citing concerns over recent reports of $1.2 billion in fraudulent payments through Ohio’s Medicaid program.

The U.S. House Oversight’s Task Force on Defending Constitutional Rights and Exposing Institutional Abuses held a hearing onWednesday to examine recent reports of Medicaid fraud, costing taxpayers in Ohio as much as $1.2 billion.

Rep. Brandon Gill, R-Texas, said home-based care services are responsible for a large portion of the fraud in Ohio. He said fraudulent actors falsely testified to providing home healthcare services in order to receive benefits from the Medicaid program.

“Fraudsters are billing Medicaid for personal care services that were never actually provided in many cases,” Gill said.

Rep. James Comer, R-Ky., called for greater verification measures to fight against bad actors who misuse taxpayer dollars. He said fraud is ingrained in these Medicaid programs

“Medicaid was created to be a temporary safety net program and what’s happened – especially in the states that expanded Medicaid – is it’s become an entitlement,” Comer said.

Ohio State Auditor Keith Faber, who is running for attorney general, pushed for more funding in the implementation of technology to verify the location of Medicaid service providers. His office identified 15% to 16% of home healthcare services were not processed through the congressionally mandated tracking systems. He said this amounts to $1.1 billion in fraudulent payments.

“Technology alone does not permit fraud,” Faber said. “Oversight agencies must have the staffing, political tools, and authority necessary to identify suspicious patterns and to act quickly when concerns emerge.”

Faber called for more tangible detailed solutions that states and providers can work toward, such as expanding predictive analytics, improving data sharing across the states, providing screening processes, and improving prepaid use systems, which require users to pay for a product before using it.

Ohio Senate Minority Leader Nicki Antonio, D-Lakewood, said Faber and the Republican majority over the last 15 years in the state legislature have overseen fraud across Ohio. In 2025, Republican majorities in the legislature abolished the state's Joint Medicaid Oversight Committee, of which Antonio was a member. 

The oversight committee, established in 2014, cracked down on pharmacy benefit managers. The committee created a single PBM system, which requires entities to get verified through the Ohio Department of Health.

Antonio estimated the reform would save $140 million and put a stop to anti-competitive business practices. She cited Republican failures as an explanation for the lack of fraud enforcement.  

"They hold the House, Senate, Governor's office and four statewide offices," Antonio said. "If there is fraud in Medicaid it is happening under the Republican majority's watch. Perhaps it's time to clean Ohio's house."

Faber defended his record on fraud enforcement over the past several years. He said his office has worked on identifying fraud in Medicaid programs since 2019 and secured 162 convictions, 366 fraud charges and $28 million in recoveries since January 2019.

He called for more support from the federal government to tackle the levels of fraud in Ohio's programs. Faber said weaknesses in verification programs have allowed certain fraudulent actors to slip through the cracks. 

"Historically, these verification programs are just not robust," Faber said. 

Rep. Andy Biggs, R-Ariz., applauded Faber’s efforts to expose fraud in the state’s Medicaid systems.

“Every dollar that is going somewhere else in the way of waste, fraud, or abuse, is a dollar that can't be used for some amount of the system legitimately,” Biggs said.

Democrats on the committee warned the pursuit against fraud could negatively impact businesses that provide legitimate services and deprive individuals of healthcare.

Rep. Lateefah Simon, D-Calif., said Republicans on the committee have attempted to strip Medicare and Medicaid services from eligible providers through legislation including the “One Big Beautiful Bill.”

“Medicare and Medicaid protect hundreds of thousands of people in our country and provide them with healthcare so they can stay healthier,” Simon said. “Actually, in the long run it's cost effective.”

The Oversight committee’s hearing comes amid the Trump administration’s efforts to crack down on fraud in federal benefit programs. Vice President JD Vance is set to visit Ohio on Thursday for a conference on federal fraud enforcement actions.